Mindfulness-based Group Therapy for Women with Provoked Vestibulodynia

Provoked vestibulodynia (PVD) is the most common cause of painful intercourse in women of reproductive age and research supports psychological approaches in the management of chronic pain. We developed a four-session group treatment for women with PVD that relied mostly on mindfulness meditation skills along with education and some discussion of cognitive theory. A total of 85 women were assigned either to immediate treatment (n = 62; mean age, 39 years) or to a 3-month wait-list condition followed by treatment (n = 23; mean age, 40 years). Questionnaires and a genital pain assessment were administered at pre- and post-treatment, and at 6 months follow-up. Women assigned to the two groups did not significantly differ on any measure at baseline. During the pretreatment wait-list period, there were significant improvements in pain self-efficacy, and non-significant improvements in feelings of helplessness, and sex-related distress. Pain self-efficacy, pain catastrophizing, genital pain induced by a cotton swab exam, pain hypervigilance, and sex-related distress all improved with treatment. There was no change in pain with intercourse. Pretreatment genital pain was the best predictor of post-treatment genital pain. Genital pain at 6-month follow-up was predicted by pretreatment genital pain, change in pain self-efficacy, and number of comorbid chronic pain conditions. Taken together, these findings support the use of a brief mindfulness-based program as a promising treatment for distressing genital pain.